Gillon T.E.R.,Medical Center |
Von Dadelszen P.,University of British Columbia |
Magee L.A.,University of British Columbia |
Magee L.A.,Womens Hospital and Health Center
PLoS ONE | Year: 2014
Background: Clinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice. Methodology & Principal Findings: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3-1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≥80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi) delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii) active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i) definitions of pre-eclampsia and severe pre-eclampsia; (ii) target BP for non-severe hypertension; (iii) timing of delivery for women with preeclampsia and severe pre-eclampsia; (iv) MgSO4 for non-severe pre-eclampsia, and (v) postpartum maternal monitoring. Conclusions: Existing international HDP CPGs have areas of consistency with which clinicians and researchers can work to develop auditable standards, and areas of inconsistency that should be addressed by future research. © 2014 Gillon et al.
Ordean A.,St Josephs Health Center |
Ordean A.,University of Toronto |
Kahan M.,University of Toronto |
Kahan M.,St Josephs Health Center |
And 3 more authors.
Canadian Family Physician | Year: 2013
Objective To describe the characteristics of a national cohort of pregnant women on methadone maintenance treatment (MMT) and to provide treatment outcome data for integrated care programs. Design Retrospective chart review. Setting Three different integrated care programs in geographically distinct cities: the Toronto Centre for Substance Use in Pregnancy in Toronto, Ont; the Herzl Family Practice Centre in Montreal, Que; and the Sheway clinic in Vancouver, BC. Participants Pregnant women meeting criteria for opioid dependence and attending an integrated care program between 1997 and 2009. Women were excluded if they were on MMT only for chronic pain. Main outcome measures Patient demographic characteristics, concurrent medical and psychiatric disorders, and substance use outcome data. Results A total of 102 opioid-dependent pregnancies were included. The mean age was 29.7 years and 64% of women were white. Women in Montreal were more likely to have partners and had fewer children. Differences in living and housing situations among the sites tended to resolve by the time of delivery. Almost half of this cohort tested positive for hepatitis C. Women had a high prevalence of depression and anxiety across all sites. Half of this cohort was on MMT before conception and for the other half, MMT was initiated at a mean gestational age of 20.7 weeks, resulting in a mean dose of 82.4 mg at delivery. At the first visit, polysubstance use was common. Prescription opioid use was more frequent in Toronto and heroin use was more prevalent in Vancouver and Montreal. For the entire population, significant reductions were found by the time of delivery for illicit (P < .001) and prescription opioids (P = .001), cocaine (P < .001), marijuana (P = .009), and alcohol use (P < .001). Conclusion Despite geographic differences, all 3 integrated care programs have been associated with significant decreases in substance use in pregnant opioid-dependent women.
Inglis A.J.,University of British Columbia |
Hippman C.L.,University of British Columbia |
Hippman C.L.,Womens Hospital and Health Center |
Carrion P.B.,University of British Columbia |
And 3 more authors.
Archives of Women's Mental Health | Year: 2014
Women with a history of major depressive disorder (MDD) have increased risks for postpartum depression, but less is known about postpartum mania in this population. The objectives of this study were to prospectively determine the frequency with which mania occurs in the postpartum among women who have a history of MDD and to explore temporal relationships between onset of mania/hypomania and depression. We administered the Structured Clinical Interview for DSM IV disorders (SCID) to pregnant women with a self-reported history of MDD to confirm diagnosis and exclude women with any history of mania/hypomania. Participants completed the Edinburgh Postnatal Depression Scale and Altman Self-Rating Mania Scale (ASRM) once during the pregnancy (∼26 weeks) and 1 week, 1 month, and 3 months postpartum. Among women (n = 107) with a SCID-confirmed diagnosis of MDD, 34.6 % (n = 37) experienced mania/hypomania (defined by an ASRM score of ≥6) at ≥1 time point during the postpartum, and for just over half (20/37, 54 %), onset was during the postpartum. The highest frequency of mania/hypomania (26.4 %, n = 26) was at 1 week postpartum. Women who experienced mania/hypomania at 1 week postpartum had significantly more symptoms of mania/hypomania later in the postpartum. A substantive proportion of women with a history of MDD may experience first onset of mania/hypomania symptoms in the early postpartum, others may experience first onset during pregnancy. Taken with other recent data, these findings suggest a possible rationale for screening women with a history of MDD for mania/hypomania during the early postpartum period, but issues with screening instruments are discussed. © 2014 Springer-Verlag.
Van Toen C.,University of British Columbia |
Van Toen C.,Analysis Group Inc. |
Sran M.M.,Simon Fraser University |
Sran M.M.,Womens Hospital and Health Center |
And 2 more authors.
Spine | Year: 2012
Study Design. Mathematical model, combined with and verified using human subject data. Objective. (1) To develop and verify a lumped-parameter mathematical model for prediction of spine forces during backward falls; (2) to use this model to evaluate the effect of floor stiffness on spine forces during falls; and (3) to compare predicted impact forces with forces previously measured to fracture the spine. Summary of Background Data. Vertebral fractures are the most common osteoporotic fractures and commonly result from falls from standing height. Compliant flooring reduces the force at the ground during a backward fall from standing; however, the effect on spine forces is unknown. Methods. A 6-df model of the body was developed and verified using data from 10 human subjects falling from standing onto 3 types of compliant floors (soft: 59 kN/m, medium: 67 kN/m, and firm: 95 kN/m). The simulated ground forces were compared with those measured experimentally. The model was also used to assess the effect of floor stiffness on spine forces at various intervertebral levels. Results. There was less than 14% difference between model predictions and experimentally measured peak ground reaction forces, when averaged over all floor conditions. When compared with the rigid floor, average peak spine force attenuations of 46%, 43%, and 41% were achieved with the soft, medium, and firm floors, respectively (3.7, 3.9, 4.1 kN vs. 6.9 kN at L4/L5). Spine forces were lower than those at the ground and decreased cranially (4.9, 3.9, 3.7, 3.5 kN at the ground, L5/S1, L4/L5, and L3/L4, respectively, for the soft floor). Conclusion. Lowering the floor stiffness (from 400 to 59 kN/m) can attenuate peak lumbosacral spine forces in a backward fall onto the buttocks from standing by 46% (average peak from 6.9 to 3.7 kN at L4/L5) to values closer to the average tolerance of the spine to fracture (3.4 kN). © 2012 Lippincott Williams & Wilkins.
Hodgson Z.G.,Womens Health Research Institute |
Abrahams R.R.,Womens Health Research Institute |
Abrahams R.R.,University of British Columbia |
Abrahams R.R.,Womens Hospital and Health Center
Journal of Obstetrics and Gynaecology Canada | Year: 2012
Objective: The purpose of this study was to explore the effect of our rooming-in protocol on the need to treat withdrawal in the opiateexposed newborn. Methods: We reviewed the medical records of mother-infant dyads born between October 1, 2003, and December 31, 2006, who received care in our rooming-in program. Data on the type of drug used by the mother, maternal methadone dose at delivery, morphine treatment of the baby, and perinatal outcome were considered. Results: We found a significant positive relationship between maternal methadone dose at delivery, "other opiate" use, and breastfeeding and the need to treat the neonate for withdrawal. We also found the maternal methadone dose at delivery to be related to the duration of pharmacological treatment of the neonate. Conclusion: Our findings suggest a role for our rooming-in program in mitigating the relationship between maternal methadone dosage and the need to treat opiate withdrawal in the newborn. Consideration of the role played by the mother-infant dyad model of care needs to be considered in future studies. © 2012 Society of Obstetricians and Gynaecologists of Canada.
Riddell L.,Womens Hospital and Health Center |
Varto H.,Vancouver Coastal Health Research Institute |
Hodgson Z.G.,Womens Health Research Institute
Canadian Journal of Human Sexuality | Year: 2010
This exploratory, descriptive study investigated the motivations and practices behind the phenomenon of pubic hair removal among women. A final sample of 660 women aged 16-50 years who had ever removed their pubic hair completed surveys asking about their reasons for, methods of, and side effects associated with this practice. Based on their usual practices for areas of hair removal, bikini line was reported by about 50% of participants and whole pubic area by about 30%. Shaving, salon waxing, and trimming with scissors were the most common usual methods although many more reported having ever tried more than one of these or other methods. Appearance in a bathing suit was the most common reason given for pubic hair removal followed by feeling attractive and by the notion that pubic hair removal is cleaner. Side effects ever experienced were common and included razor bump and ingrown hairs but also rash, pimples, and cuts among other less common types of pubic skin traumatization. Further research is proposed to better understand the social constructs of pubic hair removal and to develop best practice guidelines for health professionals in relation to this phenomenon.
Weisstock C.R.,BC Cancer Agency |
Rajapakshe R.,BC Cancer Agency |
Bitgood C.,University of British Columbia |
McAvoy S.,BC Cancer Agency |
And 4 more authors.
Cancer Prevention Research | Year: 2013
Breast cancer risk estimations are both informative and useful at the population level, with many screening programs relying on these assessments to allocate resources such as breast MRI. This cross-sectional multicenter study attempts to quantify the breast cancer risk distribution for women between the ages of 40 to 79 years undergoing screening mammography in British Columbia (BC), Canada. The proportion of women at high breast cancer risk was estimated by surveying women enrolled in the Screening Mammography Program of British Columbia (SMPBC) for known breast cancer risk factors. Each respondent's 10-year risk was computed with both the Tyrer-Cuzick and Gail risk assessment models. The resulting risk distributions were evaluated using the guidelines from the National Institute for Health and Care Excellence (United Kingdom). Of the 4,266 women surveyed, 3.5% of women between the ages of 40 to 79 years were found to have a high 10-year risk of developing breast cancer using the Tyrer-Cuzick model (1.1% using the Gail model). When extrapolated to the screening population, it was estimated that 19,414 women in the SMPBC are considered to be at high breast cancer risk. These women may benefit from additional MRI screening; preliminary analysis suggests that 4 to 5 additional MRI machines would be required to screen these high-risk women. However, the use of different models and guidelines will modify the number of women qualifying for additional screening interventions, thus impacting the MRI resources required. The results of this project can now be used to inform decision-making groups about resource allocation for breast cancer screening in BC. ©2013 AACR.
Inglis A.,University of British Columbia |
Lohn Z.,Womens Hospital and Health Center |
Austin J.C.,University of British Columbia |
Hippman C.,University of British Columbia |
Hippman C.,Womens Hospital and Health Center
Clinical Genetics | Year: 2014
Recent advancements in molecular genetics raise the possibility that therapeutics or a 'cure' for Down syndrome (DS) may become available. However, there are no data regarding how parents of children with DS perceive the possibility of mitigating specific manifestations such as the intellectual disability (ID) associated with DS, or curing the condition entirely. To explore these issues, we distributed a questionnaire to members of the Lower Mainland Down Syndrome Society in British Columbia, Canada. Questionnaires were completed by 101 parents (response rate=41%). A majority (61%) viewed the possibility of reversing ID in DS positively, but only 41% said that they would 'cure' their child of DS if it were possible. Twenty-seven percent of respondents said they would not 'cure' their child, and 32% were unsure if they would 'cure' their child. The most commonly cited motivation for opting for a 'cure' was to increase their child's independence. However, parental attitudes' towards a 'cure' for DS were complex, affected by ethical issues, perceived societal values, and pragmatic factors such as the age of the individual and long-term care-giving burden. These findings could be used by healthcare professionals supporting families who include a member with DS and to direct future research. © 2014 John Wiley and Sons A/S.
Bretherick K.L.,University of British Columbia |
Bretherick K.L.,Institute for Child and Family Health |
Fairbrother N.,Institute for Child and Family Health |
Fairbrother N.,Womens Hospital and Health Center |
And 5 more authors.
Fertility and Sterility | Year: 2010
Objective: Female fertility declines with age; however, women are increasingly delaying childbearing until later in their reproductive years. One of the factors that may contribute to this trend is a general lack of knowledge about the decline in fertility with age. Design: Self-report survey. Questions pertained to participant demographics and childbearing intentions, and knowledge of the decline in fertility and increased risk of pregnancy loss with age. Setting: The University of British Columbia in Vancouver, British Columbia, Canada. Patients: Female undergraduate students (N = 360). Intervention(s): None. Main Outcome Measure(s): Knowledge of fertility over the life span, predictors of age of intended childbearing. Result(s): Although most women were aware that fertility declines with age, they significantly overestimated the chance of pregnancy at all ages and were not conscious of the steep rate of fertility decline. Surprisingly, women overestimated the chance of pregnancy loss at all ages, but did not generally identify a woman's age as the strongest risk factor for miscarriage. Conclusion(s): Education regarding the rate at which reproductive capacity declines with age is necessary to avoid unintended childlessness among female academics and professionals. © 2010 by American Society for Reproductive Medicine.
PubMed | University of British Columbia and Womens Hospital and Health Center
Type: Journal Article | Journal: Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC | Year: 2017
There is conflicting evidence regarding the association between metformin and endometrial cancer risk. The objective of this study was to evaluate the association between type of diabetic pharmacotherapy and endometrial cancer risk within a population-based study. The hypothesis was that metformin was associated with the lowest risk.This was a nested case-control study using data from the BC Cancer Registry (2000-2009) and from a province-wide prescription network (PharmaNet) since 1996. Patients were classified by drug exposure (metformin, thiazolidinediones, secretagogues, with or without insulin). The primary analysis was a conditional logistic regression to estimate the odds ratios for endometrial cancer in the drug exposure groups. Sensitivity analysis was carried out to account for uncertainty regarding various parameters. The secondary analysis evaluated the effect of dosage using a principal components analysis.The study cohort comprised 492 cases and 4404 controls. The primary analysis revealed no difference in endometrial cancer risk between those using metformin and those prescribed other classes of medications (OR 1.5, 95% CI 0.9 to 2.4). Women receiving all classes of medications had almost a two-fold increase in risk (OR 1.9, 95% CI 1.1 to 3.3). The secondary analysis revealed an increased risk associated with a greater duration of treatment and number of prescriptions (OR 1.3, 95% CI 1.2 to 1.4).In this population-based study, metformin was not associated with a decreased endometrial cancer risk. Women receiving multiple types of medications over a long time had the highest risk, implying that the extent of insulin resistance, rather than the effect of any specific medication, drives endometrial cancerrisk.